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The search for a qualified weight loss surgeon can be completed in a number of ways. Some of the more common methods include:

Personal referral from someone you know

Referral from your primary care practitioner

Online search

Author/Expert Publication such as a journal or the book you are reading

Local marketing (i.e. radio, billboard, TV, newspaper or other publication)

Remember to ask the questions reviewed in my previous blog. Evaluate the available options and select the surgeon, staff and program that will best fit you and your needs. This is a decision that requires careful consideration. Talking to someone who has already had surgery with the surgeon you are considering is often very helpful.

You will want to attend an on-site seminar with the surgeon (not just his/her assistant or office staff). This is a great way to get to know the surgeon, learn about the various procedures he/she performs, their particular outcomes, the comprehensive program they offer, get to meet their staff and learn more about your options. If you are unable to attend an on-site seminar, many surgeons also offer a comprehensive online webinar such as the one on our website at www.cfwls.com.

This is a great question and one that isn’t asked often enough. Understandably, your initial focus is usually on researching the available surgical options. After that, your next focus tends to be who will perform your surgery, where your surgery will be performed and how much it will cost. Unfortunately, the focus doesn’t usually turn to one of the most important considerations – what you need to do to guarantee your results after weight loss surgery.

The reality is that everyone loses weight after weight loss surgery (particularly with the gastric bypass and sleeve gastrectomy procedures). It’s exciting! It’s rewarding! It’s awesome! But…eventually…your weight loss slows down and you will plateau. Don’t despair, with proper support and guidance, you can get through plateaus and the final plateau will ideally be somewhere just above your ideal body weight.

This occurs, especially if you use the time after surgery (particularly the first year) to not only lose weight, but learn how to modify your mindset and your lifestyle habits…for good! If you do this, your potential for true long-term success is exponentially increased. Remember, weight loss surgery is a tool to lose weight. If you don’t fully understand how to properly use your tool, your results can be compromised. Instead, why not optimize your results? This is where your post-operative comprehensive program comes in. Don’t skip this important aspect of your research process prior to surgery.

This may be disheartening to hear because you might think of weight loss surgery as a guarantee. Don’t get me wrong, I see success each and every day and it is truly amazing! However, weight loss surgery is not a magic bullet. Long term success requires long-term changes. Don’t worry though. With proper comprehensive support, this process is not only rewarding and fulfilling, it is actually fun!

So…What should you do after weight loss surgery to guarantee your results? This was reviewed somewhat in Chapter 10 but I am going to expand this explanation. I will begin with identifying the most common things you should be doing and then I will take a slightly different approach and share with you the five most common culprits to poor/slower weight loss or eventual weight re-gain.

In addition to the actions described in Chapter 10, your post weight loss surgery steps to success should include:

Don’t miss your post-operative visits with your surgeon. It is important for him/her to monitor your recovery and progress. Sometimes people avoid their visits because either they are feeling so great, they don’t think they need to be seen or they are struggling and too embarrassed to see their surgeon due to a perceived sense of failure. Unfortunately, this is the time you REALLY need to come in for your visits. If you feel great, you can confirm your progress and celebrate even more. If you are doing well, your surgeon WANTS to see you and celebrate with you as well. If you are struggling, your surgeon WANTS to see you to help you identify the reason(s) why you are struggling. It is best if this occurs as early as possible so you can take necessary actions to get back on track as soon as possible. You are not alone and recommendations can usually be determined quickly. You can leave with a plan in hand and the confidence you need to master the use of your new tool and get back on your path to success.

Don’t miss any scheduled visits with your primary care provider. This is particularly important if you are on any medications that need to be adjusted as you lose weight (i.e. hypertension and diabetes medications).

Don’t miss any scheduled visits with your team of weight loss coaches. Included in comprehensive programs such as the one offered at the Center for Weight Loss Success, you will also be coached by a dietician, weight loss coach and/or personal trainer. These professionals help you navigate the specific barriers or situations that may impede your optimal progress. They will also keep you on track and guide you through this life changing experience. In addition, your team loves to help you celebrate your success and assist you to avoid pitfalls and create new habits that keep you headed in the right direction.

Make the most of the educational materials provided to you before and after surgery. At the Center for Weight Loss Success, you receive a comprehensive pre-operative and post-operative learning series called Weight Management University for Weight Loss Surgery™. This program is reviewed at your office visits guides you each step of the way for the first 12 months after surgery. Each monthly module explains what to expect that month, what to expect the next month, success stories, recipes and educational materials explaining what you need to know. They also include information regarding nutrition, metabolism, fitness and other topics that assist you to attain your optimal success. The modules are supported videos in your membership site and homework assignments that help put it all together. This comprehensive system is well received by patients. By the end of your first year after surgery, you will feel as if you have earned a new degree in weight loss surgery! No matter what learning method you prefer, all bases are covered so dive on in and enjoy!

Attend the support group provided by your experienced surgeon/center. These are generally offered in a group setting and often supplemented with online support as well.

Surround yourself with positive and supportive people who have healthy behaviors. Beware of saboteurs. There will usually be someone at work or at home who intentionally or unintentionally attempts to sabotage your new way of life. Sabotage comes in many forms. Here are a few strategies for dealing with the most common types:

Self-Sabotage: Hard to admit, but sometimes we are our own worst enemies. Do you have an internal dialogue that sounds like a tug of war between something you want to do and a rationalization as to why you can’t possibly do that today (better known as excuses)? It all starts with a realistic goal, a realistic plan and realizing that you are in control of your own behavior. Try replacing the word “can’t” with the word “won’t” the next time that happens and your “self-talk” will begin to change!

Family/Friends: You like to think they are all supportive but the reality is that those we count on the most for support are often the ones encouraging a “treat”, “celebration”, “one more bite” or those trigger foods that you can’t say no to. The truth is that you are vulnerable right now and they need to understand your dedication to your goal. You may need to have a “heart-to-heart” asking for their support. Be assertive, keep your goals handy, put treats out of site or give them away, focus on activities rather than food events. At parties, focus on conversation and go in with a plan of attack you know you can stick to.

Vacations: Time away should be a time to enjoy and relax. However, be careful about your sabotaging thoughts to “let loose”, “do nothing” or “blow it out for the week”. You can have fun in moderation, incorporate a new sport or activity, enjoy new foods (focus on protein, new vegetables or fruit) and feel great by working in a long walk, run or visit to the fitness center at that great resort!

Office Life: Why is it that your office has to celebrate every event with cakes, cookies & donuts? Let your co-workers know you are trying to get healthier and welcome them to join you. Start a new office healthy thinking initiative. Avoid trips to the snack-laden break room and take your break outside. Make a point not to eat at your desk or if you have to, only bring things you know fit into your plan. Keep a stretch band or small weights at your desk to use. You could use eight different muscle groups in an eight-hour day!

Holidays/Parties: We need to celebrate life! It can be done though without all of the focus being on food and/or alcohol (which diminishes our sense of control). Plan for the event ahead of time and don’t go hungry. You will be less tempted. Plan on picking one or two special food items, giving yourself permission to sample what is there…you don’t want to feel deprived. Keep your alcohol consumption absent or to a minimum and stay hydrated with water with a twist of lemon or lime. Hold your drink in your dominant hand to avoid picking at food and talk to others…it’s harder to eat while you are talking.

You can overcome these problem areas! Make sure you identify what is risky for you so you can have a game plan to combat the situation(s). Don’t prevent yourself from enjoying life but sometimes (especially early on in your weight loss until new habits are developed) it is easiest to limit exposure, make small strides, build your confidence and then celebrate your success!

Another way to look at how to achieve long-term success is to know and understand the most common reasons you might not get the results you desire and what to do about them. Below are the five most common culprits to poor/slower weight loss or eventual weight re-gain:

Depression – Emotional health is as important as physical health. Although depression is not a problem for most after surgery, it can be a significant deterrent to optimal weight loss. It is important to identify depression (admit that it is ok) and seek appropriate treatment so you can move on with your weight loss journey.

Not Exercising – We require each of you to complete a fitness evaluation with a personal trainer which is included with the program. The reason for this is because we believe some form of consistent exercise is essential for optimal success. You should determine what form of exercise is right for you and begin your exercise plan before surgery. We cannot over-emphasize the importance of this factor. Although most find it difficult to begin an exercise plan, those that take that plunge never regret it. It can only enhance your weight loss experience and progress.

Drinking High Calorie Liquids – Many do not realize the excessive amount of sugar and calories contained in some liquids (i.e. Gatorade, Juice, Soda). As a result, you may “waste” calories on such liquids. This can significantly impede your weight loss. It is better to choose water, water with lemon, Fruit2O, Crystal Light or other low or no calorie drink options.

“Grazing” – After the first 2 months or so, you should have progressed to three meals per day with some higher protein snacks in between. If not, you may develop the habit of “grazing” or eating throughout the day. If this is the case, you tend to take in a significantly higher amount of calories throughout the day (more than what your body needs). This will slow down your weight loss and can potentially cause weight re-gain. Please guard yourself against such habits.

Eating and Drinking at the Same Time – When you eat and drink at the same time, the food is “washed through” the stomach quickly. It is important to hydrate yourself by drinking a low/no calorie beverage approximately 30 minutes prior to eating. In this way, your hunger will be decreased. When you eat, you should not drink at the same time. As a result, your “pouch” will remain fuller for a longer period of time. Thus, you will remain satisfied for a longer period of time. Be sure to stop eating before you truly feel “full”. It is a slow communication from your stomach to your brain to indicate a feeling of fullness. Thus, you may overeat and realize it too late. This can be a very uncomfortable feeling.

So although you may be focusing on the surgery itself, you will be doing yourself a big favor by not neglecting your post-operative plan. Use these tips and don’t forget to enjoy this journey of self-discovery.

Yes, you will need to take vitamins. Supplements are helpful but not a requirement. Actually, whether or not you have weight loss surgery, you should be taking vitamins. Supplements can be helpful as well, especially if you are trying to lose weight. You should also make sure your vitamins/supplements are pharmaceutical grade so that the quality of their content is monitored and guaranteed. The nutritional store at the Center for Weight Loss Success only carries such vitamins and supplements and our patients love them. (www.cfwls.com)

The common vitamins that will likely be recommended for you (may vary depending upon the surgeon) include the following:

Multivitamins: Taking vitamins will be a lifelong commitment for all patients who have had weight loss surgery. In the beginning, you should take two chewablecomplete multivitamins each day. At one month after surgery, you may be able to progress to taking two regular vitamins daily. We recommend two vitamins each day during the first year when your weight loss is most rapid. After the first year, you should continue to take one multivitamin a day. Women may want to consider a prenatal vitamin if pre-menopausal.

B-Complex: Usually around 1 month after surgery, we recommend that you also add one B-Complex vitamin each day (or even 2 per day). The B vitamins assist in muscle and nerve functioning and have been shown to increase a person’s energy level over time. You cannot overdose on B vitamins. If you take in more than you need, you will simply rid yourself of any excess through your urine. It is common for B vitamins to cause your urine to be darker or a brighter yellow. This is normal. If you prefer, B-Complex is also available as an injection at the office as appropriate.

Essential Fatty Acids (EFA’s): Take them – they’re just good for you. By taking fish oil supplements, Omega-3 fatty acids are ingested in their biologically active form. They can be directly used to support cardiovascular, brain, nervous system, and immune function. The mini-soft gels are smaller and have a natural lemon flavor to prevent a “fishy” after taste. Our product is ultra-filtered to guarantee removal of mercury and other possible contaminants. Most people should take 2-4 soft gels per day. They are also helpful to prevent constipation.

Magnesium-Potassium: During weight loss your body will tend to waste both magnesium and potassium. Both of these minerals are essential to normal muscular and cardiovascular function. Magnesium is involved in over 300 biological reactions throughout the body. It can help prevent/treat fatigue. If you are prone to muscle cramps – you need to add this supplement. Typical doses are 1-4 tablets daily with food.

The short answer is “Yes”. Exercise is extremely important following weight loss surgery because you will be losing weight at a rapid pace. Your body will try to fight this weight loss by attempting to store fat for this perceived starvation. Your body does this by burning muscle mass and storing fat. This is undesirable. To combat this effect, it is important to exercise regularly so that your metabolism is increased and your body burns fat rather than muscle mass.

If you decide to have weight loss surgery, you should seize this opportunity after surgery and integrate activity/exercise into your daily routine. This will not only help you through any plateaus, it will help you build muscle, enhance your metabolism and overall energy, and greatly influence your overall success.

I encourage walking beginning the day of surgery to improve circulation. Early walking forces the heart to pump blood throughout the body and prevents it from pooling in your legs which could cause clots that are potentially life threatening. The more walking you can do, the better. We ask that you avoid lifting heavy weights or doing sit-ups/abdominal crunches until you are at least 4 weeks from your surgery. Prior to that time, you may ride an exercise bike, or swim (not until 2 weeks from your surgery). When you choose your particular exercise program, make sure it incorporates weight training along with some form of aerobic/cardiovascular exercise.

Most everyone knows the benefits of exercise – it’s just doing it that is difficult. We all can find excuses (not enough time, not enjoyable/boring, inconvenient, lack of resources, don’t know how, etc…). The bottom line is that you must make time for exercise and make it a priority. This is easy to say, but hard to do.

The benefits of exercise are many. Some of these benefits include:

Decreased appetite

Decreased blood pressure

Decreased stress level

Reduced risk for development of heart disease

Reduced risk for colon and other cancers

Reduced depression and anxiety

Improved balance and independent living

Improved digestion

Improved self-esteem

Improved flexibility

Improved energy levels

Improved sleep pattern

Improved sexual satisfaction

Improved overall quality of life

So you may logically understand the benefits of exercise. If you still choose not to exercise, you must ask yourself “why?” Determine your roadblocks to exercise and then identify solutions to the roadblock. Once you “get the fever” for exercise after doing some form on a regular basis, you will wonder why you didn’t do it earlier. If you choose weight loss surgery, you are making a life changing decision. Maximize the benefits of this decision and commit to a regular exercise program. You will not regret it. Your weight loss will be enhanced and your overall quality of life improved.

It does take time and effort to get started. In addition, after you have had surgery, you may have some feelings of fatigue for the first one to three months after surgery. Until you can begin a more vigorous exercise program (4 weeks after surgery), walk as much as possible. If you are unable to walk due to a health problem/disability, perform as much upper body exercise as you can tolerate using light weights (until 4 weeks after surgery). If you have cardiac/respiratory problems, be sure to obtain clearance for starting an exercise program from your primary care physician and/or specialist.

Choose a fitness program that will work for you. It should be tailored to your specific needs, abilities, preferences and activities that you will enjoy. Otherwise, you will be tempted to quit.

Remember that at the Center for Weight Loss Success, we love making fitness fun and specialize in starting wherever you are. We work privately with our patients and offer three personal training sessions as a part of their Weight Management University for Weight Loss Surgery™ program. Our certified trainers love working with clients at all levels of fitness. You can also participate in our Group Fitness classes as a part of your program. Remember, you are not alone. Please use these resources available with your experienced bariatric surgeon/center to enhance your weight loss and improve your overall health and metabolism.

When starting a workout program, take it easy. Be sure to gradually work up to at least 30 minutes of vigorous exercise three or more times a week. Stick to it and strive to make exercise a habit (usually considered a habit once performed regularly for at least three months)! You won’t see dramatic changes overnight but you will see dramatic changes over time.

When you exercise, be sure to warm-up prior to the activity and cool down/stretch after the activity. Do not lift too much weight (increase weight gradually), and remain hydrated – be sure to drink water before and after your workout.

You wouldn’t think this would be a commonly asked question but it is. You may have heard a horror story about a “person who had weight loss surgery and lost so much weight that they look pale, weak and all of their skin sags”. This is by far the exception and not the norm.

Weight loss after weight loss surgery is consistent and rapid (primarily with the gastric bypass and sleeve gastrectomy procedures and not as rapid with the laparoscopic adjustable gastric banding procedure). Eventually, the body recognizes this rapid weight loss and as a protective mechanism, will slow down your metabolism and you will experience a plateau. By following your prescribed eating plan (we make it as simple as possible) and incorporating fitness, you can work through these plateaus. Once you get closer to your goal weight, the body naturally stabilizes at an appropriate weight even if you continue with a lower food intake (if it is the right combination of macronutrients and overall calories). The industry commonly calls this the “set point”. If you did continue to lose weight and appear as if you were dropping below your ideal body weight (rare), we can teach you how to use your “tool” to gain weight as well.

If you looked like the person described previously, you would need to be sure you were following up with your experienced bariatric surgeon. Some things that can contribute to such a situation include poor nutrition, lack of an adequate amount of protein, not taking your daily vitamin, iron deficiency, smoking, depression or a physical malabsorption problem. Again, this is a rare situation. If you follow the prescribed post-operative comprehensive program set forth by your experienced bariatric surgeon/center this would be avoided.

Rhonda’s Opinion: I actually did lose a little too much weight but worked with Dr. Clark and a trainer to gain back muscle. The great thing is that now YOU have CONTROL!!!

Your feelings regarding life after surgery will likely vary depending upon how far out you are from surgery, your level of preparation prior to surgery, your ability to manage change and your overall attitude/mindset. Rest assured, there is often not a dry eye in the office as goals are met/exceeded throughout the first year after surgery and beyond. It’s extremely rewarding for you and everyone involved and you hear more often than not “I wish I would have done this sooner”. As a generalization, at the Center for Weight Loss Success, we have found that most people go through a few expected phases and the timeframe for each varies:

Phase 1: What have I done?

Phase 2: I can do this.

Phase 3: I am glad I did this.

Phase 4: I wish I would have done this sooner!

Phase 5: I need to stay on track (especially if necessary long term success habits throughout the first year after surgery weren’t developed)

At the time of this publication, the primary surgery performed by Dr. Clark at the Center for Weight Loss Success is the sleeve gastrectomy. In fact, most of these patients go home the same day of surgery since you generally recover better in your own home environment. You go through a thorough pre-operative program and your post-operative program begins right away.

When you first go home from the hospital, here are some general guidelines for what to expect. Of course, each surgeon has their own particular orders so be sure to follow whatever he/she recommends.

With regards to your diet, you will want to make sure you are staying hydrated by sipping all day. You will usually continue with a liquid diet until you are seen by your surgeon 10-14 days after surgery. You should not have any carbonated beverages – refer to your the liquid diet instructions set forth by your surgeon. You need to stay hydrated and do your best to try to get about 80-100 grams of protein in per day with high quality protein shakes (again, follow your surgeons specific orders).

You will want to be up and walking as tolerated and rest when you are tired. You are usually permitted to shower. Common sense comes into play here. If anything is hurting you then you probably should not be doing it yet. At the Center for Weight Loss Success, we restrict lifting to no more than 20 pounds for the first two weeks and restrict driving for 3-4 days after surgery as long as you are off of your pain medication. Getting up and moving is a good thing. Not only for your body but for your emotional state as well.

Your surgeon will have specific instructions for wound care and medications. Follow these as instructed.

It is not unusual for you to question “What did I do?” the first days after surgery. It is a big adjustment and although you won’t likely feel hungry, just drinking liquids is a big change and can be difficult to get used to. The first few days tend to be the worst and then you get used to it. It helps to focus on your goals. This will all be worth it.

Make sure you go to all of your scheduled follow-up appointments and call your surgeon if you have any questions/concerns.

After the first two weeks, you will generally be able to begin “mushy” foods. At the Center for Weight Loss Success, we have a thorough educational program that guides you through exactly what to do/eat which is beyond the scope of this book. Your experienced bariatric surgeon/center will likely have similar resources for you.

At approximately one month after surgery, you will begin eating more regular foods. You will want to focus on getting in an adequate amount of quality protein (at least 90 grams), staying hydrated (sometimes thirst is mistaken for hunger) and easing into a regular exercise regimen. Your experienced bariatric surgeon/center will have an entire plan set to help guide you through each phase after surgery. Remember, it is never too early to begin your habits for success. As a general rule, these include:

Eating – Don’t skip meals. Food choices should be low fat and low sugar. Think “Protein First”. Eating should be approached as “how little can I eat and be satisfied”, NOT “how much can I fit into my new smaller stomach”. You will want to cut your food up into small pieces, use a smaller plate, put your fork/spoon down in between bites and chew slowly. It is best to eat at a table and not “on the run” so you will avoid eating too fast, overfilling your pouch and end up with unnecessary pain or difficulty.

Drinking – Try to avoid drinking with your meals since it “washes” the food through quicker and decreases your ability to stay fuller longer. Beverages should be non-caloric and non-carbonated. Drinking 8 glasses of water each day is a good idea with any weight loss plan. Avoid alcoholic beverages.

Vitamins – Multivitamins should be taken daily – Forever. Other vitamins and/or supplements may be needed depending upon individual needs.

Sleeping – Make sure you are well rested. You will be most successful if you sleep an average of 7 hours each night.

Exercise – Regular exercise is extremely important and should be done at least 3-4 times per week for at least 30-40 minutes.

Personal Responsibility – Successful patients take personal responsibility for weight loss/weight control. It’s up to you!! No one else can lose the weight for you. The surgery is only a “tool”. You have to use this tool appropriately.

Every person recovers at a different rate. It is important to take it one day, one week, and one month at a time. Be involved in your pre-operative and post-operative educational program and try to attend a support group once a month. Being around others who are experiencing the same thing or who have a long-term success story to share is very helpful. When you get to that point, be sure to share your success as well. Celebrate your accomplishments along the way and reward yourself with something non-food related such as a massage, manicure, pedicure, golf club, fitness center membership, new piece of exercise equipment or a great piece of clothing. You will not want to invest a large amount of money in clothing because of rapid weight loss. Joining a clothing exchange with other weight loss surgery patients is helpful too.

Finally, surround yourself with like-minded successful people who support you and your goals. There are plenty of saboteurs in this world – they may even be your closest family or friends. This is a topic we could write an entire book about! In short, ask them for their support and explain the changes you want and need to make (use “I” statements and own your goals). If they continue to be unsupportive, you may need to limit your time with them. I know this is easier said than done but it is ok for you to be selfish – this is your time to shine! Go for it!

How to best prepare for weight loss surgery is one of those questions that might not be on the top of your list, but will contribute to your overall level of success. As you know, weight loss surgery is an important decision. If you are adequately prepared, your level of anxiety will decrease and you will be better able to manage the changes required of you after surgery. In addition, with preparation comes confidence. This is a great trait to have as you embark upon this remarkable journey.

So how do you prepare for weight loss surgery? You will want to ask questions. You will want to make sure that your bariatric surgeon/center has a very thorough educational process in place prior to and after surgery that addresses nutrition, behavior modification and fitness. These three components are critical to long term success.

You may only be thinking short term. Let’s face it, you are really busy and have many obligations at home, at work, with school and with friends that take precedence over your needs. It’s easy to tell yourself “I will figure this out” but it is a lot easier if you have a support system in place at home and with your bariatric surgeon/center prior to surgery so that you can better manage any surprises that may come along the way.

If you have already decided to have weight loss surgery, you will want to think about the positive changes you want to accomplish. Often people view surgery from a number perspective (i.e. how many pounds they would like to lose). Weight loss surgery is about so much more than that. It is about enabling yourself to accomplish things that might not have been possible in the past. It is about having an exciting life. Life you can experience to the fullest extent. It is very important to think about (and document) life goals related to your weight loss. Then you can celebrate the positive changes transforming your life. Some of the “dreams” that people have shared include:

Walking up the stairs or to the corner of their street without getting short of breath

Playing with their children or grandchildren

Crossing their legs

Painting their toenails

Stop worrying about being able to fit into a chair at a public place or worrying that it will break when they sit on it

Fitting in a bathtub and having water on both sides

Shopping in a store for regular sized people

Riding a bicycle

Returning to a productive lifestyle

Stop worrying about going to a restaurant that might only have booths or chairs with arms on them

Going to a movie and fitting into the seat

Take some time to identify your “wish list” and document it. Then spend some time getting your mind and body ready. In the weeks or days before surgery, you need to consider yourself in training. Just as athletes prepare for a race, you can prepare yourself to be in top form for surgery. When you actively get your body and mind ready you likely will:

Have fewer complications from anesthesia and surgery

Be able to cooperate with necessary treatments

Heal faster and feel better quicker

Have better control of your pain

There are some very specific things you need to do to be in the best shape possible. You need to begin these things as soon as possible. We know that the very worst time to try to learn things is right after surgery when you may feel foggy from anesthesia and uncomfortable from your operation. Learn and practice these things now so that you will be able to help yourself after surgery.

Focus on healthy eating. The better nourished you are, the more quickly your tissues will heal. Healing is WORK for your body. Good nutrition helps you tolerate the stresses on your body and to offset limits on food and fluids right after surgery. Weight loss prior to your surgery can decrease your risk and improve recovery time after surgery. This is why you should incorporate your new eating plan and individualized weight loss counseling prior to surgery as a part of your overall plan. Consult your bariatric surgeon for specific options for weight loss prior to surgery.

If you are a smoker – QUIT! Even a few weeks of not smoking increases the safety of anesthesia. You will not be allowed to smoke while hospitalized. You will need all your oxygen for healing.

Build your exercise tolerance. Toning your muscles and building your strength will help you bounce back quicker. Walking is a perfect exercise for you prior to surgery. It is normal to feel a little weak after surgery, but you can reduce this by toning up with daily exercise.

Exercise your lungs! Practice your deep breathing. After surgery you will be encouraged to do this. Expanding your lungs helps your system get rid of anesthesia drugs quickly, helps prevent pneumonia, and speeds oxygen to your tissues to help you heal quickly. You will also FEEL better.

Move your legs to prevent blood clots!!!! After an operation, the best exercise to help your circulation and reduce your chance of blood clots will be walking! The nurses in the hospital will get you up after a brief recovery period following surgery. Once you go home, follow the specific discharge instructions set forth by your surgeon. In general, you should rest as needed but also get up and walk around as much as tolerated. You can do these exercises in bed or sitting in a chair during any rest periods.

Lying on your back in bed, “walk” your feet toward your body until your knees are fully bent. Tighten your abdominal muscles while you do this. Now let your legs slide gently back to the flat position and repeat this four more times.

Lying in bed or sitting up, point your toes as if you were trying to bend your foot backwards. Hold for the count of five and relax. You should feel a “pull” on the muscles in the front of your legs. Next point your heels away from your body, tightening your leg muscles. Hold for the count of five and relax. You should feel this pull in the back of your legs. Repeat the pointing exercises 5-10 times.

If you have decided to have surgery, you also need to focus your mind on a good outcome. You are the most important player in this team effort, and much will depend on your ability to fully participate. Your feelings and thoughts will play a very big part in your recovery. Reassure yourself that the best people, equipment and techniques are supporting you during surgery.

Finally, if you have decided to have surgery, a good way to prepare is to use the power of your relationships to gather a support group. Enlist family and friends to help you keep your spirits up. Let friends and neighbors help with chores and meals. We all do better when we know we are supported by people who care about us and are cheering us on. Don’t underestimate the power of your emotions. Positive thinking is the biggest help you can give yourself. Think hopeful, optimistic thoughts about the experience ahead, and start NOW!

If you do all of these things, you will be best prepared for a positive experience and outcome.

We’re ready to help you achieve your dream – view our online Weight Loss Surgery Webinar or schedule the next

If your insurance doesn’t cover weight loss surgery, you are not alone. Unfortunately, according to the American Society for Metabolic and Bariatric Surgery, less than 1 percent of those who meet the criteria for surgery actually have surgery5. A big reason for this is lack of insurance coverage.

If you find you do not have insurance coverage, there are self-pay options available (some more affordable than others). The self-pay cost of weight loss surgery procedures varies by the type of procedure and geographical area in which it is offered (urban areas tend to have a higher fee). Generally speaking, the average cost for a gastric bypass ranges from $18,000 to $25,000, while the adjustable gastric banding surgery costs anywhere from $17,000 to $30,000. The sleeve gastrectomy procedure is newer and a price range is not as readily available. A ball Park Range is anywhere from $14,000 to $22,000. The price range is also influenced by the supportive program aspects that may or may not be included, the number of follow-up visits, and for the laparoscopic adjustable banding, whether or not any adjustments are included.

The self-pay cost of weight loss surgery generally includes the cost of anesthesia, the hospital facility fee and the surgeon’s fee. There may also be additional costs for diet and fitness plans, behavioral modification therapy and nutritional products before and/or after surgery. However, some fees include these services. For example, at the Center for Weight Loss Success, our comprehensive weight loss surgery pricing including the costs for anesthesia, the hospital and the surgeon is as follows:

Gastric Sleeve – $13,995.00

Laparoscopic Adjustable Gastric Band – $16,995.00

Gastric Bypass – $18,995

However, in addition, an exclusive comprehensive 12 month program is included with these fees. It is called Weight Management University for Weight Loss Surgery™ and includes the following:

You may be surprised that all of these products/services are included, but it’s the right thing to do for optimal long term results and has resulted in a high degree of patient satisfaction and improved outcomes. For those that travel for surgery, some services are offered online instead of on-site. No matter who you choose as your bariatric surgeon, make sure that there is a comprehensive program available and ongoing support prior, during and after surgery.

Also, most experienced bariatric surgeons/centers have financing options available. You will want to verify this and explore your options. How much is adding 5-7 years of quality life worth to you?

Rhonda’s Opinion: You will find a way to pay for it…I did and I did not make very much money at the time at all. You are worth it and Dr. Clark’s program is one of the most comprehensive and affordable programs available anywhere.

Self-Pay Weight Loss Surgery is common – we offer the most comprehensive and affordable options on the East Coast! Learn more at: Self-Pay Surgery

Insurance coverage for weight loss surgery varies by state and by the insurance provider. While some insurers may cover the entire bill, many public or private insurance companies will pay a percentage (usually around 80%) of what is considered “customary and usual” for the surgery as determined by the insurance company. The first step if you are considering weight loss surgery is to contact your insurance provider (use the provider number on your insurance card) and ask “Is weight loss surgery a covered benefit under my policy?” Many policies require that the employer providing the policy purchase a “Ryder” for weight loss surgery. Thus, you might also want to ask “Do I have the Ryder for weight loss surgery on my policy?” The employer must purchase this Ryder for everyone that is covered under the plan, not just a select few. There are a number of factors that play into this decision for employers. However, generally speaking, employers who understand the value of weight loss and the employee benefits (improved/resolved co-morbidities, lower health care and medication costs, less time missed from work and increased productivity to name a few) are more likely to purchase the weight loss surgery Ryder.

If your initial attempt to authorize coverage is denied, you can appeal, and you should initiate your appeal immediately. Your experienced bariatric surgeon/center will assist you with this process. It makes good fiscal sense for your insurer to foot the bill for your weight loss surgery. According to the Obesity Action Coalition, the upfront costs of weight loss surgery are paid off in three and a half years, due to hospitalization cost savings. What’s more, the cost of drugs for people with diabetes and high blood pressure plummet following weight loss surgery. Many are able to stop taking such medications altogether as their blood sugar and blood pressure return to normal levels after weight loss6.

Medicare, the U.S. government health plan as know today for people 65 years of age or older states it will pay for three types of weight loss surgery for patients who are treated in “high-volume” centers that achieve low mortality rates. The three types of surgeries as we know it today include:

The Roux-en-Y bypass

Open and laparoscopic biliopancreatic diversions

Laparoscopic adjustable gastric banding

An experienced bariatric surgeon/center can guide you through the Medicare requirements that need to be documented prior to scheduling surgery. Medicare does not pre-authorize weight loss surgery so you will need to make sure all requirements are met prior to surgery and submitted properly with your claim. Some private insurers require a letter of medical necessity from a doctor before they will agree to pay for weight loss surgery. However, Medicare does not require pre-certification and does not pre-authorize weight loss surgery. As a result, many surgeons may ask Medicare patients to sign a contract stating that they will pay for any costs that Medicare does not cover after processing the claim. You can find out your specific requirements regarding diet history by contacting your local Medicare provider. However, at the time of this publication, weight loss surgery is an option for Medicare beneficiaries if they have a body mass index (BMI) of 35, with at least one health problem related to obesity such as heart disease or diabetes. As you are aware, governmental insurance is currently under debate and potential revision. Thus, you will want to work closely with your experienced bariatric surgeon/center.

Rhonda’s Opinion: It wasn’t covered by my insurance – that’s ok – just do it and move into the future. As I said earlier, you should qualify yourself instead of letting a stranger at an insurance company make your health decisions for you.

Dr. Clark and the Center for Weight Loss Success offer the lowest cost options on the East Coast. Learn more at: Self Pay Surgery

Is weight loss surgery reversible? The answer is “yes” and “no” depending upon the type of weight loss surgery procedure that is performed. Again, the purpose here is not to create confusion, but the bottom line is that you should not go into weight loss surgery with the mindset that it is reversible. First time (primary) weight loss procedures have risk. Secondary operations have a much higher risk primarily due to potential scar tissue, potential hernia formation and the fact that your anatomy has already been altered to a certain degree depending upon the type of primary operation performed.

Weight loss surgery may be reversible for the adjustable gastric banding procedure since the device can be removed. With the gastric bypass, it is anatomically reversible since the parts of the stomach and small intestine can technically be put together again, but it is not recommended and carries a higher degree of risk. For the sleeve gastrectomy, this procedure is not reversible since the portion of the stomach that is removed in order to create your new “medium banana sized” pouch cannot be replaced.

You have to go back to your need, your desire and your motivation for surgery. It’s a commitment that can reap benefits beyond your imagination. Fear is natural and you have to make sure you have done your research and you are as comfortable as possible with your decision. A certain amount of anxiety is actually desirable. It usually means that you realize you are making an important decision that will require a behavioral change (which is scary) but if you choose carefully and surround yourself with supportive people and proactively prepare for the potential obstacles, success will follow.